Correlates of Unmet Dental Care Need among HIV-Positive People

Jeanty, Yves; Cardenas, Gabriel; Fox, Jane; Pereyra, Margaret; Diaz, Chanelle; Bednarsh, Helene; Reznik, David; Abel, Stephen; Bachman, Sara S.; Metsch, Lisa R.

doi:10.1177/00333549121270s204

Cited by 26 publications

(35 citation statements)

References 17 publications

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“…Treatment fatigue after years of HIV surveillance and antiviral treatment were also mentioned in a small number of cases as reasons for not seeking oral care in addition to medical care. Consistent with other studies, another cited barrier was that maintaining their physical health posed significant challenges that occupied the primary focus of their attention, leading to low prioritization of oral health care , . It therefore becomes imperative that dental professionals, as well as healthcare professionals in general, promote the importance of proper oral healthcare as an extension of patient's overall general health and help patients to better understand the interrelated physiological relationship between systemic and oral health.…”

Section: Discussionmentioning

confidence: 59%

Barriers and facilitators to dental care among HIV‐Infected adults

Parish

Siegel

Pereyra

et al. 2015

Special Care in Dentistry

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Oral health problems can significantly compromise HIV-infected individuals’ general health and well-being, yet many of them experience an unmet need for oral care. The barriers and facilitators of obtaining dental care in a sample of HIV-infected adults, all of whom were eligible for Ryan White Part A funding for their treatment, were investigated through qualitative interviews with HIV-positive individuals who had not received dental services in the prior 12 months (n = 44). Identified barriers were as follows: (1) dental anxiety and fear, (2) cumbersome administrative procedures, (3) long waits at the dental office, (4) problem focused care-seeking behavior, (5) transportation difficulties, (6) dentists’ reluctance to treat people like them, and (7) psychological issues. Identified facilitating factors were as follows: (1) coverage for dental care, (2) being treated with respect and acceptance, and (3) having an assigned case manager or social worker. Many of the barriers uncovered in this qualitative study can be addressed and overcome by case management services, but other approaches are needed to address the additional psychological and stigma-related factors that are impeding access to oral healthcare in this population.

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Section: Discussionmentioning

confidence: 59%

Barriers and facilitators to dental care among HIV‐Infected adults

Parish

Siegel

Pereyra

et al. 2015

Special Care in Dentistry

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“…Several enabling factors such as “employment vs being unemployed,” “having living difficulties,” “not having a regular dentist,” “dental anxiety,” and “avoiding dental treatment due to cost” were associated with self‐reported dental treatment need. As reported among many other underserved and marginalized populations, inability to afford care remains a major barrier to receiving dental care . In fact, more than 50% of this current study's respondents reported unmet dental treatment needs in association with high dental treatment costs and/or not having dental insurance.…”

Section: Discussionmentioning

confidence: 66%

What are the self‐reported unmet dental treatment needs of people living with HIV in British Columbia? A case of minority subpopulation in Canada

Jessani

Aleksejūnienė

Donnelly

et al. 2020

J Public Health Dent

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Objectives To identify associations of Andersen and Newman's (A&N) predisposing, enabling, and need factors with self‐reported oral health status and self‐reported unmet dental treatment needs in a sample of people living with HIV (PLHIV) in British Columbia (BC), Canada. Methods Participants responded anonymously to a 41‐item online questionnaire with the following inclusion criteria: a) be at least 19 years old; b) self‐identify as HIV‐positive; c) be able to provide consent and be willing to voluntarily participate in the study; d) be residing in British Columbia; and e) be able to proficiently respond to the questions in English. Following the descriptive statistics, associations between A&N model factors and the main outcome variables (self‐reported oral health status and self‐reported dental treatment needs) were evaluated using bivariate inferential analyses. Results A total of 186 participants met the inclusion criteria. Approximately 40% (n = 74) of participants rated the health of their mouth as fair/poor and more than half (n = 112; 60.2%) reported having bleeding gums, tooth decay or tooth sensitivity. The bivariate analysis for the self‐reported oral status as the outcome variable showed “having fair/poor general health” (P = 0.001), “unemployment” (P = 0.019), “avoiding dental treatment due to cost” (P = 0.005), and “not visiting a dental professional within the last year” (P < 0.001) as the strongest predictors. For the second outcome variable unmet dental treatment needs, the strongest predictors were “experience of being discriminated by dental professionals” (P = 0.001), “having fair/poor general health” (P = 0.006), and “suffering from past and current medical conditions due to HIV” (P < 0.001). Conclusions Several predisposing, enabling and need factors from the A&N model were associated with self‐reported oral health status and unmet dental treatment needs of PLHIV. Results from this study highlight the needs of improving access to affordable dental care to address the unmet oral health needs of PLHIV.

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“…It should be noted that the poor periodontal health and low median nadir CD4 + T cell count of our cohort may both reflect poor access to care. Further, while HAART and/or immune reconstitution may help ameliorate PD, other factors, such as smoking status[23], access to ongoing dental care[30,31,32], dental anxiety[33], psychosocial stress, concomitant medical conditions, oral health literacy[34], oral hygiene skills[35]—and, as per this study, nadir CD4+ T-cell count, may influence the long-term risk for ongoing chronic periodontal disease in this population. …”

Section: Resultsmentioning

confidence: 99%

Effect of Nadir CD4+ T Cell Count on Clinical Measures of Periodontal Disease in HIV+ Adults before and during Immune Reconstitution on HAART

et al. 2013

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BackgroundThe contribution of HIV-infection to periodontal disease (PD) is poorly understood. We proposed that immunological markers would be associated with improved clinical measures of PD.MethodsWe performed a longitudinal cohort study of HIV-infected adults who had started highly active antiretroviral therapy (HAART) <2 years. PD was characterized clinically as the percent of teeth with ≥1 site with periodontal probing depth (PPD) ≥5.0mm, recession (REC) >0mm, clinical attachment level (CAL) ≥4.0mm, and bleeding on probing (BOP) at ≥4 sites/tooth and microbiologically as specific periodontopathogen concentration. Linear mixed-effects models were used to assess the associations between immune function and PD.ResultsForty (40) subjects with median 2.7 months on HAART and median nadir CD4+ T-cell count of 212 cells/μl completed a median 3 visits. Over 24 months, CD4+ T-cell count increased by a mean 173 cells/µl (p<0.001) and HIV RNA decreased by 0.5 log10 copies/ml (p<0.001); concurrently, PPD, CAL and BOP decreased by a mean 11.7%, 12.1%, and 14.7% respectively (all p<0.001). Lower nadir CD4+ T-cell count was associated with worse baseline REC (-6.72%; p=0.04) and CAL (9.06%; p<0.001). Further, lower nadir CD4+ T-cell count was associated with a greater relative longitudinal improvement in PPD in subjects with higher baseline levels of Porphyromonas gingivalis (p=0.027), and BOP in subjects with higher baseline levels of Porphyromonas gingivalis or Treponema denticola (p=0.001 and p=0.006 respectively). Longitudinal changes from baseline in CD4+ T-cell count and level of HIV RNA were not independently associated with longitudinal changes in any clinical markers of PD.ConclusionDegree of immunosuppression was associated with baseline gingival recession. After HAART initiation, measures of active PD improved most in those with lower nadir CD4+ T-cell counts and higher baseline levels of specific periodontopathogens. Nadir CD4+ T-cell count differentially influences periodontal disease both before and after HAART in HIV-infected adults.

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Correlates of Unmet Dental Care Need among HIV-Positive People

Cited by 26 publications

References 17 publications

Barriers and facilitators to dental care among HIV‐Infected adults

Barriers and facilitators to dental care among HIV‐Infected adults

What are the self‐reported unmet dental treatment needs of people living with HIV in British Columbia? A case of minority subpopulation in Canada

Effect of Nadir CD4+ T Cell Count on Clinical Measures of Periodontal Disease in HIV+ Adults before and during Immune Reconstitution on HAART

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